chronic angle closure glaucoma
Introduction
Introduction to chronic angle-closure glaucoma The pathogenesis of chronic angle-closure glaucoma (chronicangle-closureglaucoma) is not very clear. When the IOP is elevated, the anterior chamber angle is closed. There is no congestion in the front of the eye during the attack. The symptoms are not obvious, and there are no symptoms and signs of acute attack. According to the shape of the iris and anterior chamber angle, it is divided into two types, the iris bulging type and the iris high pleat type. Most patients have a history of recurrent episodes, characterized by varying degrees of eye discomfort, paroxysmal optic palsy and rainbow vision. Winter and autumn episodes are more common than in summer, and most occur in the evening or afternoon. After sleep or rest, The intraocular pressure can return to normal, the symptoms disappear, and a few people have no symptoms. basic knowledge The proportion of sickness: 0.004% - 0.006% Susceptible people: no specific population Mode of infection: non-infectious Complications: iridocyclitis, malignant glaucoma
Cause
Causes of chronic angle-closure glaucoma
Can occur in all age groups of adults, no significant gender differences, local anatomical features of the eye similar to acute angle-closure glaucoma, emotional disorders, excessive fatigue, may be the cause of elevated intraocular pressure.
1. Internal cause
Anatomical and physiological factors.
(1) variability and genetic defects in the normal range of anatomical structure: such as small eyeball, small cornea, hyperopic eye, shallow anterior chamber, and high pleat red film at the end, making the anterior chamber shallow angle narrow, leading to aqueous humor Discharge obstacles.
(2) Physiological changes: pupillary block, narrow anterior chamber angle, moderate dilation of the pupil is an important condition, coupled with the increase of age, the crystal grows with age, gradually close to the pupil edge, so that the iris and crystal The pupillary block is formed, and the posterior chamber pressure is higher than the anterior chamber pressure, and the corneal sclera elasticity is weakened, which has no compensatory ability to increase the pressure. Therefore, the peripheral iris is pushed forward, the iris bulges to close the angle of the anterior chamber, and the intraocular pressure is increased. .
2, external factors
(1) Emotional hormones: central nervous system dysfunction, cerebral cortical excitation inhibition disorder, inter-brain intraocular pressure regulation central disorder, vascular motor neurological disorders make pigmented membrane hyperemia, edema, sympathetic excitation, dilated pupils, can make iris roots To Zhoulian, blocking the corner of the room.
(2) The point is scattered and frozen, the dark room is tested or the movie is watched. If the TV is too long, the pupil is dilated, and the angle of the corner is blocked, resulting in an increase in intraocular pressure.
Increased intraocular pressure can cause a series of pathological changes in the eyeball.
1, acute stage: manifested as intraocular circulatory disorders and tissue edema, corneal edema, iris ciliary body congestion, edema and even exudation, expansion of the bulbar conjunctiva, retinal vasodilation, congestion and even bleeding.
In the early stage of acute angle-closure glaucoma, the iris matrix is highly congested and edematous, and the iris root is displaced forward and in close contact with the trabecular meshwork, making the anterior chamber angle narrower or completely occluded. During this period, the anterior chamber angle is only in contact with each other, and the machine has not yet occurred. After the acute phase sign is removed, the symptoms of the acute phase can be relieved. If the iris root and the trabecular meshwork are in contact for a long time, the iris matrix and the anterior trabecular meshwork are fibrotic and degenerated, resulting in permanent adhesion. The occluded anterior chamber will no longer be open, the stent is also deformed by compression, and the corner of the chamber permanently loses the function of aqueous drainage.
2, chronic stage: manifested as tissue degeneration or atrophy, such as corneal degeneration caused by bullous keratitis, iris ciliary body atrophy and pigmentation, retinal optic atrophy and typical papillary glaucoma cup formation.
Primary glaucoma is mostly bilateral, which can occur successively and has a family history of genetics.
Prevention
Chronic angle-closure glaucoma prevention
There are many reasons for inducing glaucoma. Dilated pupils, emotional agitation, overeating, etc. caused by various causes can affect neurovascular function and induce glaucoma.
The weather is also an important factor in inducing glaucoma. The change of weather and the alternation of the season have a great influence on the physiological function of the human eye. Glaucoma often occurs in winter, and it is usually easy to attack within 24 hours of strong cold air intrusion. When the air hits, the temperature drops suddenly, and the intraocular pressure may fluctuate greatly. The reason why cold air induces glaucoma is because the weather changes, it will affect the body temperature regulation center, and the intraocular pressure fluctuates through the nerve interference blood pressure, and then the disease occurs.
Complication
Chronic angle-closure glaucoma complications Complications, iridocyclitis, malignant glaucoma
Complications usually occur after glaucoma surgery, such as anterior chamber hemorrhage, delayed anterior chamber formation or no anterior chamber, secondary iridocyclitis, malignant glaucoma.
1. Anterior chamber hemorrhage is a clinical phenomenon, often caused by blunt contusion, perforation injury, intraocular surgery, and a small number can also occur in intraocular tumors, iridocyclitis or iris redness. Anterior chamber hemorrhage caused by blunt trauma, due to the large amount of bleeding, can lead to serious complications such as secondary glaucoma and corneal blood staining.
2. Anterior uveitis, also known as iridocyclitis, often affects the ciliary body after inflammation of the iris, so clinically separate iritis or ciliary body is rare. Often at the same time.
3. Malignant glaucoma is a kind of intractable glaucoma with difficult diagnosis and difficult to control intraocular pressure. It is generally considered to be a serious complication after glaucoma surgery. It is characterized by elevated intraocular pressure and the movement of the crystal iris forward. All anterior chambers became significantly lighter or even disappeared.
Symptom
Chronic angle-closure glaucoma symptoms Common symptoms Eyes, eye pain, eye pressure, glaucoma, oversight, dizziness, fundus, change, ciliary congestion, rainbow vision, fog
Most patients have a history of recurrent episodes, characterized by varying degrees of eye discomfort, paroxysmal optic palsy and rainbow vision. Winter and autumn episodes are more common than in summer, and most occur in the evening or afternoon. After sleep or rest, The intraocular pressure can return to normal, the symptoms disappear, and a few people have no symptoms.
1. Iris bulging type
(1) Repeated intermittent intraocular pressure rise and eye pain, often accompanied by mild hyperemia and rainbow vision, generally only a small episode, or a slight self-consciousness.
(2) There is a little pigmentation after the cornea, but there is no glaucoma, and the iris has no atrophy.
(3) When the intraocular pressure is as high as 4.7 kPa (35 mmHg), the angle of the anterior chamber is partially closed, but when the intraocular pressure drops back to normal, the angle of the anterior chamber returns to normal.
(4) Prompt test - positive test in darkroom and darkroom prone.
(5) In the late stage of the disease, glaucomatous changes occur in the fundus and visual field.
2, high pleat iris type
(1) There was no obvious symptoms in the early stage, and the ore was slowly increasing.
(2) The root of the iris is long, the entrance to the corner is narrow, the surface of the iris is flat, the central anterior chamber is deep, and the angle is short.
(3) The pupil is dilated.
(4) After peripheral iridotomy, dilated sputum can cause seizures.
(5) There is a typical glaucoma visual field and fundus changes in the late stage.
According to the shape of the corner, it can be divided into two types:
Iris bulging type: anterior chamber shallow, narrow anterior chamber, iris bulging, increased intraocular pressure during episodes, rainbow vision, visual blindness, dizziness, eye swelling, etc., after repeated episodes, base pressure (minimum intraocular pressure of 24 hours) Gradually, the peripheral anterior iris adhesion occurs in the corner of the room, and the back of the cornea is covered with a towel. When the eye pressure is high, the pupil is slightly enlarged.
Iris high pleats: This is a closed-angle glaucoma without pupillary block, also known as short-angle glaucoma. These patients have normal anterior chamber depth and no obvious pupil block, mainly due to the high pleats of the surrounding iris. To the trabecular site, the outflow of aqueous humor is blocked.
The iris is highly pleated, the center of the anterior chamber is deep, but the angle of the anterior chamber is narrow. Under the corner mirror, the front surface of the iris is "normal" or even slightly concave. However, the root is long and can be raised in the corner of the chamber to form a plateau. Iris, so it is also called root glaucoma. When the pupil is enlarged, the surrounding iris pleats into the narrow angle and contacts the trabeculae. At the tip of the corner, the contact, blocking the outflow of water, but the anterior chamber angle is four quadrants. The changes are not exactly the same. The width and narrowness of each quadrant are obviously different and inconsistent. This is one of the main reasons for the diagnosis of chronic angle-closure glaucoma.
1, the attack often has emotional disorders, overwork, long-term reading and other incentives, there are rainbow vision and fog, eye swelling, rest after sleep can be self-relieving.
2, there is mild or moderate ciliary congestion in the front of the eye, sometimes no congestion, the corner is a permanent permanent adhesion, is closed angle or because the surrounding iris folds against the trabecular surface, making the anterior chamber shallow, anterior chamber angle Narrow, the corner of the room is closed, and the outflow of water is blocked.
3, the intraocular pressure is suddenly increased periodically, the use of miotic agents alone can not reduce the intraocular pressure, the interval between the onset of seizures is longer, gradually increased due to adhesion of the angle of the corner, showing a constant sustained high intraocular pressure.
4, the fundus did not change in the early stage, in the late stage, the optic nerve milk did not shrink the glaucoma cup.
5, visual field damage and simple glaucoma performance similar, vision loss, and even complete loss.
Examine
Examination of chronic angle-closure glaucoma
The diagnosis of typical cases is not difficult. When the symptoms are not typical, the key is to observe the anterior chamber angle under high intraocular pressure. When the intraocular pressure is increased, the angle of the anterior chamber is narrowed, and the peripheral anterior iris adhesion is inconsistent in each quadrant. The angle of the corner is still open, and when the intraocular pressure drops to normal, the angle of the anterior chamber is widened. Therefore, observing the anterior chamber angle under high intraocular pressure and normal intraocular pressure will help identify the open angle glaucoma. Only in suspicious open-angle glaucoma with normal intraocular pressure, optic disc and visual field, and narrow angle but completely open, it is necessary to select dark room test, prone test, dilated test and other provocative tests to aid diagnosis.
Diagnosis
Diagnosis and diagnosis of chronic angle-closure glaucoma
When the symptoms are not typical, the key is to observe the anterior chamber angle under high intraocular pressure. When the intraocular pressure rises, the angle of the anterior chamber becomes narrower, and the peripheral anterior iris adhesion is inconsistent in each quadrant. Even when some of the angles are still open, and the intraocular pressure drops to normal, the angle of the anterior chamber becomes wider. Therefore, observing the anterior chamber angle under high intraocular pressure and normal intraocular pressure will help to distinguish with open angle glaucoma. Only in suspicious open-angle glaucoma with normal intraocular pressure, optic disc and visual field, and narrow angle but completely open, it is necessary to select the dark room test, prone test, dilated test and other provocation tests to aid diagnosis.
